We can´t be sure that words will save, but we know full well that silence kills!
Stories of a Doctor working in places, where humanitarian issues make "our problems" in life a bit smaller.... It wound be easier to close my eyes, but I decided to open them and share with the world what I have lived.

quinta-feira, 29 de julho de 2010

Petit Gustavo

Congo – North Kivu – Masisi -- 2009

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It has been a year since I left Portugal to go to Congo, with my bag full of dreams, fears and questions, not knowing what was expecting me in the other end of my journey… And now I am back…. back to my life trying not to forget, the feelings that I had in Congo…. My life goes on almost like nothing ever happened …. But there is something that also goes on…. the war in Congo…. not once, not even once I heard about the worst war in the world, since I came… its even difficult to search for news of what is going on, in the beautiful mountains of Eastern Congo…. the ones that die from the war, from malnutrition, from starvation, malaria or HIV…. they are just not good enough to make it to the newspaper or Tvs…. I just read today, searching for news of Africa, that the biggest killer of children under 5 is diarrhea …. 2000 kids die per day of diarrhea …. and almost all of them could easily be avoided, with very simple things…… as running water, proper hygiene and the use of a toilet…. it looks very easy doesn’t it?? But it’s not…. but everyday that we wake up worried about our stressful life, 2000 kids died the day before, because they don’t have this basics that we take for granted…. But I sincerely hope, that the kid from the story that I am about to tell you, didn’t suffer from one of the many killers of the undeveloped world…

He was 2 weeks old, and vomiting since he was born, losing weight and becoming severely dehydrated. Besides my good friend and surgeon Yaroslav, at that time we had another surgeon from Belgium, Maciel was there with many years of experience in Africa, a very wise man… and he suspected that this newborn had Pyloric Stenosis, which is a disease that affects the newborn, where the exit of the stomach is thicker than normal so the milk doesn’t go through and that causes the baby to vomit and to die from it if not treated…. So Maciel called me saying that he wanted to operate that baby the next day… So I went to see and evaluate the newborn… and of course I was a bit scarred. Every Anesthesiologist is a bit afraid of such small babies, and when they are dehydrated even worst, and when you have no lab exams to access the patient status, the task becomes even more difficult. I had seen before at home some of those cases, and they are not such a big deal, when they don’t have time to dehydrate and we know exactly what is going on with their physiologic balance… specially what we call the hydro-electrolytic balance…. fluids, acid and ions. Well, one thing was on my side….. I had no options…. if the baby is not operated, he will die, and the more we postpone the worst he gets… So I went to “eat” the books that I had with me to study all I could about that situation… the problem is that my books, don’t really prepare you for the fact that I had no lab exams, and all I could do was try to guess what was going on with that baby…. For the ones that don’t know Anesthesiology is not putting people to sleep…. its all there is about caring of a patient before, during and after the operation… and if he dies, it’s on my hands, and under my total responsibility… After doing a lot of calculations I went back to the pediatric ward and prepared the infusions, mixing fluids glucose and ions… for the baby and explain the nurses what was going on and the rate of the infusion (there were no infusion pumps, so we had to count the drip, but those nurses were very good at doing that)… It was very demanding to me to prepare for this case… and I had to mix my medical thoughts with what I read in the books adapting to the conditions that I had…. and hoping for the best……uffff…..newborns are very difficult to handle when they are critical, very unpredictable, and a small mistake can easily cost his life… During my evaluations of the baby, of course, the loving mother was paying a lot of attention, and very worried about the days to come…. And the more she saw that some Muzungus (white men) were around her 14 days old boy, the more she got stressed and asked me (with the nurses translation) what was going to happen and if the baby was going to be alright, etc…. and like always I reply in simple words with the pure truth…. That everything could happen…

The next day was just another day with many surgeries and many anesthetic procedures to do… but with a very delicate and special case…The newborn was looking a bit better after 18 hours of infusions prepared by me, and the mother delivered the baby in my hands with tears in her eyes…

In that day I went to the operational theater, very early so I could prepare all the drugs and all the material for that baby…. So everything was ready when he came…. I tried to explain as much as I could to the nurses that performed anesthesia, and that were being taught by me, but I guess that they had no idea of the challenge that it was to deal with this critical small baby… The induction of the anesthesia went smoothly and I intubated the trachea of the newborn, I followed all the calculations that I made before, during the whole procedure…. The surgeons started to operate and the diagnosis was confirmed…. the exit of the stomach was cut in order to treat this disease, and the surgery was a big success… But my concerns were still far from being over…. I had to wait and see if he was about the recover his breathing normally and if he was going to wake up ok…. It took some time but everything went great… and the baby woke up very calm, and went to the recovery room with his vital signs always normal …. We were all very happy, specially the mother… After a short explanation about the present status of the baby, making her understand that it was going to take a while for her to see him in his normal state again, she came to the recovery room (which was also the office of the operation theater) with me…. and cried of happiness after seeing that her baby was doing fine… Until I allowed her to hold him she was staring at him without blinking for a second… She was deeply concerned with the well being of her baby…. Sometimes people tend to think that because so many die, they don’t suffer the way we do…. it’s not true…. they do , just the same way….

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This was not yet the end of my job, I had to make sure that he would recover to a normal condition, with the help of the infusions and hoping that the outcome of the surgery was the way we expected and the baby could take the mother´s milk with no problem… So I followed the baby and visited him many times the days after the surgery… and the smile of that mother was wider and wider as the baby was getting bigger and bigger…. every day I could tell that he was getting better, and every day that mother was more pleased to show me the baby and pass it to my hands so I could evaluate him… It’s amazing how we can establish a relationship and strong bounds with someone that you cannot talk to, just with smiles and looks and body language, with some help of the locals to translate a few words….

The baby couldn’t be better, the mother couldn’t be happier and I was very happy too…. When they were about to be released, a week after the surgery, I went to the pediatric ward to see for the last time how was the baby doing, now with 21 days and looking great…. The mother started looking at me and talking in Swahili, (I couldn’t understand a word almost (was still busy trying to improve my French)), so a local nurse came to help and told me:

“Doctor, she wants you to choose a name for him!” In Africa they are never named before, like here… I guess it’s because you will never know what’s going to happen until the baby is ok….

And I said: “But I don’t know any names in Swahili!”

The loving mother looking at her baby desperate to hold him, while the nurse was explaining her what I was telling

The nurse translated I came back to me: “Nooo. She wants to give the baby your name!” Well, you can’t imagine the rush of adrenaline that crossed my body, I almost felt my legs shaking…. never ever nothing like that happened to me…. I became very, very emotional just from that sentence…

I said: “My name is Gustavo, ask her if she likes it!”

“She says that she likes it very much, and asks what does your name mean!” …..uuupppsss…. I have no idea…. we all read once in our lives where does our name come from… but I never really cared about that….. but in Africa it means a lot to them, so I couldn’t disappoint that woman and that baby….

So I said, “It means Strong and Brave!” showing her my muscles …. She laughed and looked very happy about it ….

I turned my back to the mother and Petit Gustavo after saying goodbye, and with tears in my eyes I went to my favorite spot of the hospital where you could see the amazing landscape that surrounded that hospital…. thinking about Petit Gustavo….

In these moments…. you see that your effort was very appreciated …. And that somebody is willing to give her baby your name just as a sign of appreciation …. all the effort makes sense now…. leaving the ones you love worried about you, makes sense… losing all the summer, losing a lot of comfort, losing money, taking risks…. All that makes sense…. And I started to think about having a child with my name in Congo….will I ever see him again?...., will he survive the war?.....will he turn a child soldier one day? Will he survive Malaria? Will he be a part of the 2000 kids that die per day of diarrhea? Or one of the many killers of Africa ?

Thought about my godson, almost 1 year old, and the luck that he had to be born in the part of the world where the health care has developed so much, and where children grow healthy almost always with no problems, ….. and Petit Gustavo had is faith almost to be decided by chance…. He was very lucky so far, to end up in a place in the middle of a war zone where surgical care was a reality… It costs a lot of money to run a project with surgical activities, and sometimes I asked myself with that money used in another way couldn’t we save many more kids, like vaccination for example?…. The answer is simple, Yes it would save more lives if used in another way…. but at the same time…. there is something that is priceless that we were offering…. Hope!!.... With a message for that population… In one of the worst places to live in this planet…. there were some white people…. coming from who knows where…. to provide good quality health care, able to treat some difficult conditions …. That I suppose, gives them good energy to live, power to continue, love to their souls…. to one day make that place a paradise on Earth as it should be…

One life was saved, but many got a strong message…. Many people all around the world, do care about what is going on in Congo… specially the ones that donate their money to Doctors Without Borders or other organizations to make our work in the field possible….

….and its to all these good people that feel happy about caring and giving that I dedicate this story….

Long live Petit Gustavo, so one day his mother will tell him the story and he can tell the world how his life was saved…. so Hope will never disappear!

What an amazing story! I had pyloric stenosis as a baby and seeing the photos meant a lot to me. Also, your heartful concern and care was also very important for me to feel. I had some emotional difficulties stemming from the early surgery and write about healing from them on my blog http//:myincision.wordpress.com. One thing that most impressed me is how you interpretted Gustavo as "strong and brave." This message is exactly what little ones with pyloric stenosis need to hear. He will grow up with a positive image of his babyhood and his medical experience, which is crucial. Bravo to both Gustavos and thank you for your story! (fyi, I'm from the U.S.)

Thank you, thank you for this moving story. You give us a wonderful taste of your heartfelt, skillful and careful work for this baby and his mother, the challenges of infant surgery and the practice of medicine in many parts of the world, and the touching story and photos of the mother's anxiety and enormous relief as she keeps vigil beside her recovering babe. I had the same surgery at the same age in 1945, and realise this would have been even more basic and stressful. No wonder my parents could never talk. And how grateful I am for your story and pictures.

Gusto,I'll write in english as you asked.I knew that you hab been in Congo with the DWB, but I never realized the overwhelming experiences you went through. I read your blog from top to bottom and all I can say is that, in the in the midst of all the horrors and atrocities that many people all over the world have to endure, the support you provide is priceless. We known each other from a completely different cenario, where none of this had ever been discussed. Thus I want to say here that I truly admire your courage and your sense of duty and will, from now on, look at you with renewed respect.Thank you.Artur Melo